5. Heterogeneity and sensitivity analyses for the combination of alpha‐foetoprotein (AFP) (cut‐off 20 ng/mL) and ultrasonography (US).

Subgroup	N of studies	Sensitivity (95% CI)	Specificity (95% CI)	P value
All	6	96% (88% to 98%)	85% (73% to 93%)	‐
case‐control	0			‐
cross‐sectional	6	96% (88% to 98%)	85% (73% to 93%)
prospective	3	91% (84% to 95%)	91% (75% to 97%)	0.578
retrospective	3	97% (83% to 99%)	77% (66% to 85%)
before 2000	2	95% (44% to 100%)	81% (69% to 89%)	0.703
after 2000	4	96% (89% to 99%)	87% (69% to 95%)
cirrhosis > 10%	6	96% (88% to 98%)	85% (73% to 93%)	‐
cirrhosis < 10%	0
Europe	1	100% (83% to 100%)	74% (67% to 80%)	§
America	2	79% (54% to 94%) 90% (77% to 97%)	87% (79% to 94%) 83% (79% to 87%)
Asia	3	99% (98% to 100%) 91% (81% to 96%) 94% (71% to 100%)	68% (66% to 71%) 98% (96% to 99%) 82% (81% to 84%)
Africa	0
HCC prevalence < 10%	3	96% (78% to 99%)	80% (76% to 84%)	0.100
HCC prevalence > 10%	3	95% (79% to 99%)	90% (68% to 97%)
clinical suspect	1	79% (54% to 94%)	87% (78% to 93%)	0.289
surveillance	5	97% (92% to 99%)	85% (70% to 93%)
HCC resectable < 20%	0			‐
HCC resectable > 20%	4	95% (84% to 99%)	88% (72% to 96%)
biopsy	1	99% (98% to 100%)	68% (66% to 71%)	§
OLT	1	79% (54% to 94%)	87% (78% to 93%)
other reference standard	4	93% (86% to 97%)	88% (72% to 95%)
viral < 80%	1	79% (54% to 94%)	87% (79% to 94%)	*
viral > 80%	3	99% (98% to 100%) 91% (81% to 96%) 94% (71% to 100%)	68% (66% to 71%) 98% (96% to 99%) 82% (81% to 84%)
Child A < 50%	1	100% (83% to 100%)	74% (67% to 80%)	*§
Child A > 50%	2	99% (98% to 100%) 91% (81% to 96%)	68% (66% to 71%) 98% (96% to 99%)
US positivity criteria predefined	2	90% (77% to 97%) 94% (71% to 100%)	83% (79% to 87%) 82% (81% to 84%)	§
Full text	6	96% (88% to 98%)	85% (73% to 93%)	‐

* Sparse and missing data. Meta‐analysis not conducted

§ Model failed to converge

OLT: orthotopic liver transplantation; HCC: hepatocellular carcinoma; US: ultrasonography